My Knee Hurts...So Why Are You Looking At My Hip???

Are you struggling with knee pain? If so, you may have gone on Google and searched treatments for knee pain and found a bunch of websites that advertise injections and other temporary pain relief solutions.  I have discussed pain in past posts and again I will tell you that pain is your body giving you the “check engine” light. You have pain for a reason and shouldn’t ignore it or mask it with medication or injections.  Injections, medications, and other modalities used to relieve pain can and should be used in conjunction with other forms of treatment to help relieve pain and reduce the body’s natural inflammatory response; however, you should not rely solely on them to help make your issue go away completely. Searching the internet, you may have also came across people discussing hip strength related to reducing knee pain.  Today, I am going to discuss the diagnosis of plain old “knee pain” that I get from referring physicians and the importance of looking at the whole picture, especially hip strength. 

Knee pain can be caused by several different factors, such as trauma, acute injury, the aging process, or onset of new activities.  Knee pain is not always the result of trauma.  Most of my patients with knee pain have it for years and they have no idea how it started, while others recently started running or exercising and their body did not tolerate it too well because they progressed themselves too fast.  If you have gone to physical therapy in the past, they may have tried to give you exercises to strengthen your hips and butt and you may have looked at them like they were crazy because your pain was in your knee.  The truth is that everything is connected when your foot hits the ground and your hips are key supporters of your knee.  Your quadriceps and hamstrings help control your knee in the plane of movement that causes your knee to flex (bend) and extend (straighten).  These muscles do not tend to help much with rotation as your foot hits the ground and this is where your butt comes in handy! Your gluteus medius (as shown below) helps stabilize your knee and prevents it from rotating too much as you take each step.  It does this by stabilizing your pelvis and core, to prevent it from placing the joints below, such as your knee and ankle, in a detrimental position. 

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This detrimental position I am referring to is called dynamic valgus (shown below), or the knee moving inward with squatting, jumping, walking, transferring from standing to sitting in a chair, running, or other daily activities.  It is important to note that some people have a natural valgus at both knees, and may be subject to further wear and tear at the knee joint with increased activity levels.  The strength of your hips/glutes and the way your foot hits the ground plays a huge role in the way your entire leg absorbs impact.  If you have weak glutes, your knee joint may be absorbing more impact when your foot strikes the ground instead of your hips, which may cause pain and increased chance for joint damage.  Another thing to keep in mind is that you may also need different shoes or orthotics (shoe inserts) to help stabilize your foot as it hits the ground.  If your arch drops when you squat or walk, you may be told that you “pronate”.  This also places your knee at greater risk for injury and should be analyzed further. 

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There are so many factors that can contribute to knee pain, so proper analysis is recommended.  As a physical therapist, I take a look at the whole picture and find what is causing your knee pain.  I assess strength, range of motion, flexibility, and dynamic movement.  I also give suggestions for proper footwear and orthotics, as well as assess running mechanics if my patients run frequently.  My main goal is educating the patient to help fix the problem and prevent it from reoccurring in the future.  If your knee pain is caused by trauma, I assess the integrity of ligaments, muscles, and tendons around the area and refer to a physician for imaging, such as x-rays or MRIs, if my findings warrant further investigation.  I use modalities such as ultrasound, electrical stimulation, and ice/heat to help reduce inflammation and pain in the area to aid healing.  I recommend a combination of knee and hip strengthening exercises to my patients to help them improve their mechanics as they move.  Usually, with a combination of modalities for pain, flexibility and strengthening exercises, my patients are pain free within a few weeks.  (Please note that healing time varies by the person, lifestyle, age, and anatomy) If you want your knee pain further evaluated today, give us a call. It’s never too late to get back to the activities you love most!

608-222-2325